Helen Stojic, spokesperson for Blue Cross Blue Shield of Michigan, says the decision by the insurer to eliminate coverage of gender reassignment was simply a matter of aligning their product with what is currently offered in the market.

“We took a look at our product line and what other insurers were covering in other markets,” she said in a phone interview late Tuesday night. “Most don’t cover this type of surgery. So we are aligned our products.”

Nicky

The whole health insurance thing in the states is a little bit of a mystery to me.

Not many people have health insurance in my country as most services are publicly owned and funded. Must suck needing insurance. Even if I was living on the street I could still go to hospital for an operation or if I was sick. Not that our health system is perfect...sometimes it is better to go private to avoid the waiting lists. I think SRS or similar is considered elective surgery so it comes at a cost to the user.

Oh, I hear ya. If I was back home in Canada I could get SRS covered (I'm from Ontario originally and left about 6 months prior to them re-instating it as part of OHIP). It's a learning curve but it's one that is detrimental, IMO, to the overall health of the nation.

A broad coalition of organizations, including the American Civil Liberties Union, The National Association of Social Workers, Transgender Michigan and others, are condemning a move by Blue Cross Blue Shield of Michigan to eliminate coverage for gender reassignment surgery. The new entity calls itself The Michigan Coalition for Gender Equality.

“We are concerned that BCBSM underestimates the profound impact of these medically necessary procedures,” said André Wilson of MCGE. “Gender reassignment surgeries can be a critical part of the transition process and these new exclusions will place many transgender individuals and their families at real risk.”

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“Be yourself; everyone else is already taken.” Oscar Wilde

mickie88

this really sux as this is the insurance my employer offers, but now i know i will be paying for useless insurance for myself, but at least it won't be for the kids. dammit, just more wasted money!!!!! infinite expletives!!!!!!

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fifthwheel

I've included below the full press release from Michigan Coalition for Gender Equality, which includes comments from the Executive Directors of NASW Michigan and Michigan Psychological Association (the Michigan affiliates of National Association of Social Workers and the American Psychological Association.) Unfortunately the Michigan Messenger chose to truncate this information. The public support from allied health associations such as NASW Michigan and MPA will be important in entering into dialogue with BCBSM and the state insurance commission regarding the importance of coverage for these services.

While it is true that lots of insurance plans don't cover trangender transition-related services, a growing number now do. Indeed, I would venture to say that at this point probably all of the major health insurance carriers in the USA now have at least one employer for whom they have included such services. These include Aetna, many BCBS affliliates, Cigna, HealthNet, Health Partners, Medica, UHC-United Health Care, MegaLife, and some HMOs such as Kaiser. Nonetheless it is also true that all of these also have many plans which exclude such coverage.

Some forum readers wrote that neither Kaiser (HMO) nor Anthem BCBS CA cover these services. While this may be true for the plans each of the readers has, both of these companies have written plans with inclusive coverage, and both have internal medical guidelines regarding implementation of such coverage. (the University of California's staff plans with 232,000 combined enrollees all have inclusive coverage. Their options include an HMO option with Kaiser and Anthem BCBS PPO.)

Thanks to some incredible advocacy work by individuals in their workplaces, often with support of their LGBT employee resource groups, many insurance carriers now recognize that these services are indeed medically necessary. The difficulty is that in many states, and under the federal ERISA legislation which regulates insurance offered at larger employers, there is no clear legal mandate that carriers or employers offer coverage of all medically necessary services.

The importance of the HRC Corporate Equality Index should not be underestimated in the changes that we've seen in the last few years. Although many of us would like to have seen the CEI begin this effort much earlier and their timeline move faster, many employers have already negotiated coverage for 2010. Internal workplace advocates will need to start discussions right now if they expect to make changes to 2011 plans. Nonetheless, I expect that we will see many corporations moving to fully inclusive coverage within the next two years. If and when these changes happen they will be as a direct result of internal advocacy work done over many months, even years, by employees inside these organizations who have networked with others to make the changes take place. So many of us could contribute to making a real difference, but rarely can we succeed in isolation.

DETROIT -- The Michigan Coalition for Gender Equality expressed deep disappointment regarding changes to Blue Cross Blue Shield of Michigan (BCBSM) plans that will eliminate reimbursements for gender reassignment surgeries for new customers. The Michigan Coalition for Gender Equality (MCGE) includes Affirmations, American Civil Liberties Union of Michigan, Michigan Equality, Michigan Project for Informed Public Policy, Transgender Detroit, Triangle Foundation, and the National Association of Social Workers’ Michigan Chapter.

“We are concerned that BCBSM underestimates the profound impact of these medically necessary procedures,” said André Wilson of MCGE. “Gender reassignment surgeries can be a critical part of the transition process and these new exclusions will place many transgender individuals and their families at real risk.”

The American Medical Association, American Psychological Association, National Association of Social Workers, and World Professional Association for Transgender Health have called for coverage by public and private insurers of all medically necessary procedures for the treatment of gender dysphoria or transsexualism, including gender reassignment surgeries. Treatment delays or denials for such services often lead to more serious and expensive health problems, according to the AMA, which has also called exclusions of transgender-related services discriminatory. WPATH affirms that gender reassignment surgeries are “cost-effective, not cost-prohibitive” and can be “essential to achieving well-being for the transsexual patient.”

“Many people are unaware of the distress accompanying gender dysphoria and of the damage caused by insurance exclusions,” said Maxine Thome, Executive Director of NASW Michigan. “Research shows the effectiveness of treatment, and social workers see the difference firsthand. Access to services brings dramatic improvements in health status, as well as increased employability and social acceptance.”

MCGE members learned of the BCBSM changes from the Detroit Free Press which reported, “The changes do not affect 170,000 customers already in individual Blue Cross plans or with Blue Cross insurance through their employer. But they will affect thousands losing insurance as employers drop coverage or lay off staff.” The changes were approved by Michigan’s Office of Financial and Insurance Regulation without any opportunity for public comment or input.

Some forum readers wrote that neither Kaiser (HMO) nor Anthem BCBS CA cover these services. While this may be true for the plans each of the readers has, both of these companies have written plans with inclusive coverage, and both have internal medical guidelines regarding implementation of such coverage. (the University of California's staff plans with 232,000 combined enrollees all have inclusive coverage. Their options include an HMO option with Kaiser and Anthem BCBS PPO.)

Yup and I've asked my company to include it. Apparently it's not a standard inclusion. Every year I will ask for to be included until it is. Until then, I'll work around the system as best I can (FTMs have an advantage as far as that is concerned since T does increase the risk of breast cancer and one can do preventative surgery for that).

fifthwheel

Kudos to you for asking your employer to negotiate inclusive coverage! If you work at an employer with over 100 employees (especially at a place with over 1000) then there is a pretty good chance that they can actually get the coverage; if the institutional will is developed to demand it. We see the most success when individuals are able to build a small team of internal allies who are willing to go to bat with them....

RE "FTMs have an advantage as far as that is concerned since T does increase the risk of breast cancer and one can do preventative surgery for that"

Some FTMs have tried to argue this with their insurance carriers, however as far as I can ascertain few have succeeded. Some have successfully managed to argue a family history of breast cancer. However, many have tried this and it hasn't worked. Internal guidelines vary by carrier with regard to prophylactic mastectomies, and even when carriers have such guidelines if they discover the individual is FTM they refuse coverage for the surgery.

Generally I tend to think we do not do ourselves favors by characterizing one group or another as being more or less advantaged in this process. Usually our ideas of someone else's "advantages" are based on misconceptions or half truths which do not apply to the majority of cases. I am in touch with both MTF and FTM individuals who are experiencing enormous hardship because they cannot get coverage for the services they need. These include people with employer-based private insurance, individual coverage, Medicare, Medicaid, TriCare, Vets coverage, county community health plans...

FTMs face serious problems accessing care with many carriers for a variety of reasons. For one thing, FTMs are pretty likely to need continuing "contra-gender" care unless they have had top surgery, hysto, and perhaps even genital surgery. There is probably too little evidence to say conclusively that taking testosterone increases the risk of cancer for FTMs. But what we do know for sure is that natal females with female body parts are at considerable risk for a variety of cancers including ovarian as well as breast cancer. (1 in 8 "women" will be diagnosed with breast cancer, which includes female-born FTMs who retain breast tissue. Apparently breast cancer risk is also reduced if ovaries are removed...). The overall cancer risk to natal females is reduced with regular physical exams such as pelvics and mammograms. While many insurers do manage to continue coverage of cross-gender body parts, I hear too many stories of carriers who refuse coverage.

If an FTM wants/needs to have surgeries the total out-of-pocket cost for just the top and hysto may well exceed $20,000. The number of qualified surgeons who can perform FTM genital surgeries AND who are in-network for insurance is infinitesimal. Getting anywhere close to full reimbursement on out of network services is enormously difficult. So even when coverage is offered it can be hard to use.

Basically with regards to insurance coverage there are very few things which can be assumed to be true across all carriers and across all plans issued by a carrier.

Recall too that in many instances the "carrier" is just a "third party administrator" and not an insurer. This is especially true for ERISA-regulated plans. For example, in "self-insured" plans, the employer is bearing the risk and acting as the "insurer" (generally with a re-insurer backing them up). So the employer has a lot more leeway in deciding what they will or will not cover, and can often override to some degree the internal guidelines generally implemented by the "carrier". (I've just talked with someone whose employer plan overrode their BCBS-affiliated third party administrator and approved coverage not only for genital surgery but also for breast augmentation and for "tracheal shave." While I know that a growing number of carriers medical guidelines on "SRS" now consider breast augmentation to be medically necessary, this was the first I'd hear od anyone getting the tracheal shave covered... )

fifthwheel

Generally speaking at this point in time, there is no insurance carrier whose policies always cover surgical transition. However, it is also true that nearly every major insurance carrier is known to have provided transgender inclusive coverage for at least one employer. I have been tracking insurance coverage for the past 7 years, and the list of carriers with at least one inclusive plan now includes the following major carriers and/or one of their subsidiary companies: Aetna, Cigna, EmblemHealth, HealthNet, Health Partners, Kaiser Permanente, Medica, UnitedHealthCare. Also a number of BCBS affiliates including Health Care Services Corp BCBS, BCBS Massachusetts, BCBS Michigan, Premera BCBS, WellPoint Anthem BCBS.Some United Health Care plans do cover transgender transition related care including surgeries and other procedures related to "sex reassignment." Others do not. Basically large employers have the ability to negotiate inclusive coverage through just about any insurance carrier should they choose to do so. Employee activism usually through internal LGBT employee resource groups has had significant success in getting big employers to negotiate inclusive coverage. The Human Rights Campaign Foundation Workplace Project's Annual Corporate Equality Index has found 66 major corporate employers with coverage inclusive of at least some aspects of surgical transition. Some of these have UHC plans. See: http://www.hrc.org/issues/workplace/benefits/transgender_inclusive_benefits.htm and scroll down to link for names of employers.

If you have a UHC plan right now through an employer, there are a couple of things to do to find out what is covered. First, you can ask the carrier for a copy of your plan contract and look to see if there are trans specific exclusions. If there are not, then services may be covered. If there are, then services are likely not to be covered but depending on a number of factors you might still be able to fight the exclusion. Second, you can talk to your HR benefits folks about your plan. Before doing this I strongly suggest reading this advice on maintaining privacy:http://www.hrc.org/issues/workplace/benefits/14323.htm

If the plan you are wondering about is not an employer plan, but is an individual plan or a Medicaid or Medicare plan, then right now there is little chance that services would be covered.

Also: as far as we know UHC does not have an internal medical policy or "utilization management guideline" which articulates how prior authorization or other aspects of coverage are handled. (Aetna, Cigna, Anthem BCBS, Medica, HealthNet, and some other carriers do have such guidelines. However, at this point in time all of these appear to create greater barriers than the WPATH SOC.)

If you are trying to get your employer to negotiate with their insurance carrier, I strongly suggest that you check out the info posted at the HRC websites above, and contacting HRC Workplace Project for more info. The HRC Corporate Equality Index is one of the strongest pieces of leverage available right now.

Hope this helps.

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glendagladwitch

I had an SRS revision covered under BCBS of Michigan a couple of years ago. One thing that really surprised me was the bill. They required me to use an in-state surgeon, the only one in Michigan being Dr. Wilson. His fee was less than 5K, but he does not have his own clinic, so he requires a hospital stay. I did not have to pay any of that $45,000.00 bill, but eyes sure did bug out.